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Original article
Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis
  1. Leonardo H Eusebi1,2,
  2. Raguprakash Ratnakumaran3,4,
  3. Yuhong Yuan5,
  4. Masoud Solaymani-Dodaran6,7,
  5. Franco Bazzoli1,
  6. Alexander C Ford3,4
  1. 1Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  2. 2The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
  3. 3Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
  4. 4Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
  5. 5Division of Gastroenterology, Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
  6. 6Iran University of Medical Sciences, Tehran, Iran
  7. 7The University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Alex Ford, Leeds Gastroenterology Institute, Room 125, 4th Floor, Bexley Wing, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK; alexf12399{at}


Objectives Gastro-oesophageal reflux symptoms are common in the community, but there has been no definitive systematic review and meta-analysis of data from all studies to estimate their global prevalence, or potential risk factors for them.

Design Medline, Embase and Embase Classic were searched (until September 2016) to identify population-based studies that reported the prevalence of gastro-oesophageal reflux symptoms in adults (≥15 years); gastro-oesophageal reflux was defined using symptom-based criteria or questionnaires. The prevalence was extracted for all studies, and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, OR and 95% CIs were calculated.

Results Of the 14 132 citations evaluated, 102 reported the prevalence of gastro-oesophageal reflux symptoms in 108 separate study populations, containing 460 984 subjects. Prevalence varied according to country (from 2.5% in China to 51.2% in Greece) and criteria used to define gastro-oesophageal reflux symptoms. When only studies using a weekly frequency of heart burn or regurgitation to define presence were considered, pooled prevalence was 13.3% (95% CI 12.0% to 14.6%). Prevalence was higher in subjects ≥50 years (OR 1.32; 95% CI 1.12 to 1.54), smokers (OR 1.26; 95% CI 1.04 to 1.52), non-steroidal anti-inflammatory drug (NSAID)/aspirin users (OR 1.44; 95% CI 1.10 to 1.88) and obese individuals (OR 1.73; 95% CI 1.46 to 2.06).

Conclusions The prevalence of gastro-oesophageal reflux symptoms varied strikingly among countries, even when similar definitions were used to define their presence. Prevalence was significantly higher in subjects ≥50 years, smokers, NSAID users and obese individuals, although these associations were modest.


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  • Contributors Guarantor of the article: ACF. LHE, RR, YY, MS-D, FB and ACF conceived and drafted the study. LHE, YY, MS-D and RR collected all data. ACF and LHE analysed and interpreted the data, and drafted the manuscript. All authors commented on drafts of the paper. All authors have approved the final draft of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.